Page 68 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 61

persons, both of whom at once experience and interpret the constituents
of the encounter—including themselves and one another—because of
which a focus on each person's situational definition is critical. Moral
(and other) issues are embodied and expressed through a range of
feelings that are presented solely within the contexts of their actual
occurrence—^which is itself a complex, ongoing mutual relatedness between
a person seeking help and one professing the ability to provide that help.
Although mutual, the clinical event is an asymmetrical relationship with
power (knowledge, skills, access to resources, social legitimation and legal
authorization) in favor of the professed helper, a relation that involves
physical and personal intimacies, often among strangers.
Accordingly, medicine is an inherently moral enterprise, highlighted by
that asymmetry. On the one hand, to be a patient is to be disadvantaged
by the very condition that brought one to the physician in the first place.
It is thus marked by various forms of unavoidable trust (on the part of
the one seeking help), and by taking-care-of and caring-for (on the part
of the helper). The asymmetry does not imply that the physician alone
does or should make unilateral decisions; having power-to-alter does not
signify either exercising power-for or power-over. It rather signifies power-
with: it requires, that is, the active, shared participation of both patient
(family, circle of intimates) and physician (and other providers). To be
sure, the nature of the asymmetry makes it possible (even tempting) for
the physician to take advantage of the multiply disadvantaged patient
(family, circle of intimates), but just that is morally prohibited—by the
patient's own existential vulnerabiUty. In somewhat different terms, at the
core of the asymmetrical therapeutic relationship is a special form of
dialectic between trust and care, between having-to-be-trusting (patient)
and having-to-be-trustworthy (physician).
Every impairment is experienced and interpreted by the impaired
person, for whom it has meaning. Others also experience and interpret
that impairment: the patient's family, circle of intimates (often but not
ahvays including the family), physicians and other providers, as well as
persons and institutions in the wider social ambiance. Encounters are thus
framed by cultural values, professional codes, governmental regulations,
hospital policies, unit or department protocols, etc. A clinical encounter
is a specific instance of a certain kind of context with its specific
appertaining set of multiple interrelationships, functional significances and
functional weights, as Gurwitsch astutely noted ([8], pp. 85-154; [9], pp.
175-286; [13], pp. 435-462; [39], pp. 67-109).